PT  - JOURNAL ARTICLE
AU  - Armelle Forrer
AU  - Samuel Wanji
AU  - Elisabeth Dibando Obie
AU  - Theobald Mue Nji
AU  - Louise Hamill
AU  - Kim Ozano
AU  - Helen Piotrowski
AU  - Laura Dean
AU  - Abdel J Njouendou
AU  - Relindis Ekanya
AU  - Winston Patrick Chounna Ndongmo
AU  - Ebua Gallus Fung
AU  - Dum-Buo Nnamdi
AU  - Raphael A Abong
AU  - Amuam Andrew Beng
AU  - Mathias Esum Eyong
AU  - Bertrand L Ndzeshang
AU  - Desmond Akumtoh Nkimbeng
AU  - Samuel Teghen
AU  - Anicetus Suireng
AU  - Ernerstine Ebot Ashu
AU  - Emmanuel Kah
AU  - Michele M Murdoch
AU  - Rachael Thomson
AU  - Sally Theobald
AU  - Peter Enyong
AU  - Joseph D Turner
AU  - Mark J Taylor
TI  - Why onchocerciasis transmission persists after 15 annual ivermectin mass drug administrations in South-West Cameroon
AID  - 10.1136/bmjgh-2020-003248
DP  - 2021 Jan 01
TA  - BMJ Global Health
PG  - e003248
VI  - 6
IP  - 1
4099  - http://gh.bmj.com/content/6/1/e003248.short
4100  - http://gh.bmj.com/content/6/1/e003248.full
SO  - BMJ Global Health2021 Jan 01; 6
AB  - Introduction Onchocerciasis is targeted for elimination mainly with annual community-directed treatment with ivermectin (CDTI). High infection levels have been reported in South-West Cameroon, despite ≥15 years of CDTI. The aim of this study was to assess factors associated with continued onchocerciasis transmission and skin disease.Methods A large-scale cross-sectional study was conducted in 2017 in 20 communities in a loiasis-risk area in South-West Cameroon. A mixed-methods approach was used. Associations between infection levels, skin disease and adherence to CDTI were assessed using mixed regression modelling. Different community members’ perception and acceptability of the CDTI strategy was explored using semi-structured interviews.Results Onchocerciasis prevalence was 44.4% among 9456 participants. 17.5% of adults were systematic non-adherers and 5.9% participated in ≥75% of CDTI rounds. Skin disease affected 1/10 participants, including children. Increasing self-reported adherence to CDTI was associated with lower infection levels in participants aged ≥15 years but not in children. Adherence to CDTI was positively influenced by perceived health benefits, and negatively influenced by fear of adverse events linked with economic loss. Concern of lethal adverse events was a common reason for systematic non-adherence.Conclusion CDTI alone is unlikely to achieve elimination in those high transmission areas where low participation is commonly associated with the fear of adverse events, despite the current quasi absence of high-risk levels of loiasis. Such persisting historical memories and fear of ivermectin might impact adherence to CDTI also in areas with historical presence but current absence of loiasis. Because such issues are unlikely to be tackled by CDTI adaptive measures, alternative strategies are needed for onchocerciasis elimination where negative perception of ivermectin is an entrenched barrier to community participation in programmes.